KOOTENAY MOUTAINEERING CLUB - TRIP REGISTRATION LIST
WAIVER: I hereby for myself, my heirs, executors & administrators
release and forever discharge the Kootenay Mountaineering Club, their agents,
servants, officials, representatives, successors and assignees of any injury
sustained by me or by my equipment during this club trip. I understand the
inherent dangers of trips into mountainous areas and assume full responsibility
for myself.
| DATE: |
Coordinator: |
| DESTINATION: |
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| NAME (PLEASE PRINT) |
SIGNATURE FOR WAIVER |
TEL. NUMBER OR ADDRESS |
KMC MEMBER? |
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Coordinator:
Please return this form to the summer/winter trip chairperson.
(This waiver prepared 1997/04/15. Updated 4Aug2005.)